NHA CPT Phlebotomy Flashcards

What is the proper sequence for putting on PPE?

A. Mask, gloves, gown
B. Gloves, gown, mask
C. Gown, mask, gloves
D. Mask, gown, gloves

Gown, mask, gloves

An incidient reporting system should include which of the following?

A. Potential causes
B. Details of the incident
C. Management of adverse events
D. All of the above

All of the above

Which of the following is a National Patient Safety Goal(s)?

A. ID patient correctly
B. Prevent infection
C. Improve communication
D. All of the above

All of the above

When should a sharps container be disposed of?

A. Never
B. After 1/2 full
C. When it's 3/4 full
D. Completely full

When it's 3/4 full

Which of the following is not required on a correctly completed requisition?

A. Test(s) ordered
B. Patient history
C. Priority status
D. Patient number

Patient history

The process of maintaining control of a specimen from the point of collection until testing is complete is referred to as what?

Chain of custody

Workplace safety in a lab is governed by which agency?

OSHA

Prior to drawing from a sleeping patient, what should be done?

A. Check their medical chart
B. Gently wake them, when they're ready request they provide ID
C. Verify armband and proceed with draw
D. Leave the room and return later

Gently wake them, have them provide ID

What action can prevent bruises from forming due to a blood draw?

A. Applying heat
B. Applying firm pressure after and keeping a bandage on for several hours
C. Taking ibuprofen
D. All of the above

Applying pressure

Which of the following draws can be collected after a gray top tube is drawn?

A. Blood cultures
B. Heparin rubes
C. Sodium citrate tubes
D. None of the above

None - gray is the last

Which of the following would NOT be required for a finger stick?

A. Alcohol wipes
B. Gauze
C. Micro containers
D. Syringe

Syringe

What sites should venipuncture not be performed on?

Sites with scar tissue, vascular grafts, or hematomas present

The additive 3.2% sodium citrate results in what?

The prevention of clotting by binding calcium

Which test order should be given the most priority?

A. Timed
B. STAT
C. Urgent
D. Routine

STAT

What type of draw is generally performed for patients in infancy?

A. Venipuncture
B. Heel stick
C. Finger stick
D. Arterial

Heel stick - on the medial and lateral portions of plantar surface

Which of the following is a characteristic of capillaries?

A. Capillaries are only a small part of the vascular system
B. They are found in every square inch of the human body
C. They are permeable for every substance
D. Their nails are rugged

They are found in every square inch of the human body

When a sample is rejected for QNS, what should you do?

Collect another sample with sufficient quality

Which of the following is not a primary method of venipuncture?

A. Syringe
B. Lancet
C. Vacuum tube
D. Butterfly

Lancet

Why is blood drawn in a specific order?

To avoid cross-contamination of additives

What is the first step in dealing with a patient that appears nervous?

A. Tell them to close their eyes
B. Discuss procedure in detail
C. Assess their cause for concern and provide reassurance
D. Double check with the physician to determine if the draw is necessary

Asses their cause for concern and provide reassurance

What types of safety hazard might you encounter while working as a phlebotomist? (There are 3)

Biological, electrical, and radioactive

Which of the following can reduce your risk of infection after being exposed to a bloodborne pathogen such as Hepatitis B or HIV?

A. Reporting the incident
B. Discussing the exposure
C. Taking a post-exposure prophylaxis
D. All of the above

Taking a post exposure prophylaxis

Which of the following can result in a legal or criminal action against the phlebotomist?

A. Breach of confidentiality
B. Holding a patient down to obtain a sample
C. Median nerve damage due to a negligent draw
D. All of the above

All of the above

Which of the following needle gauge sizes has the largest bore?

A. 22g
B. 18g
C. 25g
D. 21 g

18g

When a patient's vein is small, thin, or fragile, what would be the most appropriate equipment selection?

A. Straight needle
B. Evacuated tube system
C. Syringe
D. Additional bandage

Syringe

How long should a tube be pre-warmed in an incubator prior to collecting a warmed specimen, such as Cold Agglutinins?

A. 10 minutes
B. 30 minutes
C. 5 minutes
D. 60 minutes

30 minutes at 37 degrees Celsius

Which cleansing agent is typically not used on venipuncture for the collection of blood cultures or blood-alcohol specimens?

Isopropyl alcohol

What are the smallest veins in the human body?

Venules

What is an acceptable method of patient ID?

Requesting patient provide name and DOB

If a patient indicates previous experiences of fainting during venipuncture, what should be done?

Move them to an area where they can lie down during the draw

Which test requires fasting?

A. Complete blood count (CBC)
B. Iron test (TIBC)
C. Rental function panel
D. Lipid profile

Lipid profile - Fat, fasting

Which is not a standard vacuum tube size?

A. 2 ml
B. 3 ml
C. 10 ml
D. 20 ml

20 ml

Which test is not impacted by fasting?

A. Glucose
B. Cholesterol
C. Triglycerides
D. Blood culture

Blood culture

What is the smallest gauge needle used for venipuncture?

A. 18g
B. 20g
C. 23g
D. 22g

23g

What are all the tubes that contain anticoagulants?

Light blue, green, lavender, pink, grey, royal blue with EDTA

Which tube are lead levels drawn in?

Royal blue

What tube does an ESR (Erythrocyte Sedimentation Rate) go into?

Lavender

What tube does a "Lytes" panel go in?

Green

What section of the lab would process a CBC?

Hematology, complete blood count = red blood cell , white blood cells and platelets

What section of the lab would a pink top tube go? What are the additive(s) in the pink top tube?

Blood Bank - EDTA

When checking inventory, which of the following elements needs to be verified for use?

A. No heat or moisture damage
B. Expiration date
C. No visible damage to the equipment
D. All of the above

All of the above

What is the most common cause of blood culture contamination?

Improper skin preparation

Which of the following may occur if additives are not mixed adequately?

A. Erroneous test results
B. Clotting of the sample
C. A repeat draw will be necessary
D. All of the above

All of the above

What action should not be taken when first meeting a patient?

A. Introduce yourself
B. Confirm that the lab form matches their identity
C. Inquire the reason they need their blood drawn
D. Request that the patient verify their ID

Inquire the reason they need their blood drawn

Which tube color has no additive?

Red

What is the maximum depth a heel stick should penetrate?

2 mm

What is the main difference between aerterial and venous blood?

Arterial blood is oxygenated and venous blood is deoxygenated

What is the additive in a light blue top?

Sodium citrate

What is a nosocomial infection?

Healthcare setting acquired infections

What tube contains an antiglycolytic agent?

Grey

What sample needs to be run within 15 minutes of collection?

ABG

What is a fomite?

An inanimate object that transports microorganisms

What is the definition of tort?

Wrongful act that results in injury to one person by another

What is the definition of thrombophlebitis?

Inflammation of a vein with formation of a clot

Sodium fluoride keeps

A. Cellulite molecule intact for 5 days
B. Cellulose melocule intact for 4 days
C. Glycerin cell molecule in tact for 3 days
D. Glucose molecule intact for 3 days

Glucose molecule intact for 3 days

Silica is in what tube color?

Tiger top/SST

Scleroses veins are

Hard and cord-like

PTT is the abbreviation for:

Partial Thromboplastine Time

The two valves on the right side of the heart are

Tricuspid and pulmonary

The two valves on the left side of the heart are

Aortic and mitral

T/F: If a patient has a right side mastectomy it is OK to draw from the right arm?

False - Draw from opposite arm

Hemolyzed specimen is what color? What is the cause?

- Pink/red tint
- Inverted too fast/hard
- Smaller needle = More likely to hemolyze

Lipemic specimen is what color? What does this mean?

- Milky white
- High amount of lipids int he blood

Icteric specimen is what color? What does this mean?

- Green/brownish color
- High amount of bilirubin in the blood

How far above the draw site should the tourniquet be placed?

3-4 inches

Vein selection first choice to last choice:

Median cubital, Cephalic, Basilic

Angle of entry of straight needle

15-30 degrees

Butterfly gauge size is normally

23g

Under the patient's bill of rights, they have a right to...

Option to decline medical treatment and to know what tests are being performed on them.

If a patient refuses to let you draw blood, what do you do?

Report this to your supervisor

Informed consent

A competent person gives voluntary permission for a medical procedure after receiving adequate information about the risk of, methods used and consequences of the procedure

Expressed Consent

Permission given by patient verbally or in writing for a procedure

Implied Consent

The patient's actions gives permission for the procedure without verbal or written consent. Ex: Going to the ER or holding out arm when told need to draw blood

HIV Consent

Special permission is needed to administer a test which detects HIV

Parental Consent for Minors

A parent or a legal guardian must give permission for procedures administered to underage patients depending on the state law may range from 18 to 21 years old.

If a patient is allergic to latex gloves, what should you do?

Use vinyl or nitrile gloves instead

If sharps container is overflowing, what should you do?

Report the violation to your supervisor

Decontamination can be accomplished by using the following liquids

1. Solution of sodium hypochlorite (household bleach/Clorox) diluted between 1 : 10 - 1 : 100 with water
2. Lysol or some other EPA-registered tuberculocidal disinfectant

If you are exposed to blood or any other potentially infectious material, you should

1. Wash the exposed area thoroughly with soap and running water
2. Report the exposure to your supervisor ASAP
3. Refer to an MSDS (material safety data sheet)
4. Fill out an exposure form

The Complaint Inspection (OSHA Compliance inspections)

Occurs after an employee files a formal complaint with OSHA. Most common type of inspection

The Fatality/Accidents Inspection (OSHA Compliance Inspections)

Occurs after OSHA receives notice from the employer of a workplace fatality or an accident resulting in the hospitalization of 3+ employees. OSHA also takes notice of media reports, and will frequently investigate accidents that do not result in any fatalities or hospitalizations.

The Programmed Inspection (OSHA Compliance Inspections)

An inspection conducted of randomly chosen workplaces determined to be engaged in particularly hazardous types of work according to their Standard Industry Classification (SIC) Codes.

The Imminent Danger Inspection (OSHA Compliance Inspections)

Occurs when OSHA receives a report that a condition of imminent danger exists at a workplace. Least common type of inspection

The angle of entry in a hand vein with the butterfly

5 degrees

The proper steps to end a blood draw are

Remove the tourniquet, remove the tube, place gauze/cotton over the site, remove the needle, activate the safety

Methods to making difficult draws less difficult

Pre-warm the site
Palpate the site with a substantial amount of alcohol
Tighter tourniquet
Lower the arm below the heart
Hydrate the patient for 15-20 minutes before
Flex or extend the arm while feeling for veins

In pediatric blood draws (under 2 y/o) draws are done predominantly...

In the median cubital vein. You may also perform heel sticks.

Drawing blood from a patient who has an IV

You should always draw blood BELOW an IV site. If IV is in the forearm, only draw from the hand. If IV is in the hand, draw from the other arm.

If your patient faints, what's the first thing you should do?

Get the needle out of the arm

Is Prothrombin Time test (PT/INR) used to evaluate the extrinsic or intrinsic pathway?

Extrinsic pathway

What is INR?

International Normalized Ratio - No matter where you get your blood tested, the ratios will be calculated as to always correctly administer medications

Is Partial Thromboplastin Time (PTT) used to evaluate the extrinsic or intrinsic pathway?

Intrinsic pathway

Hemochron

A device used for POCT (point of care testing) regarding PT/INR would be the Hemochron Signature Elite
- Comprehensive point-of-care coagulation monitoring system

What is "basal state"?

- "Basal state" refers to fasting (nothing by mouth) and refrain from strenuous exercise for 8-12 hours prior to the blood draw.
- Fasting specimens require collection of blood while the patient is in the basal state.

What are cold agglutinins?

Antibodies produced in response to mycoplasma pneumonia infection (atypical pneumonia)
The antibodies formed may attach to RBC at temperatures below body temperature
The specimen must be kept warm until the serum is separated from the cells

Specimen drawn without stasis

Lactic Acid blood test must be drawn without stasis (without tourniquet)

Specimens that require chilling

Ammonia
Lactic Acid
Arterial Blood Gas (ABG)
Gastrin
Glucagon
Parathyroid Hormone
Partial Thromboplastin Time
Prothrombin Time

Specimens that require protection from light

Bilirubin
Vitamin B12
Urine Porphyrins
Carotene
Red Cell Folate
Serum Folate

T/F: For OGTT, blood will be drawn from a fasting patient

True

How many bottles are in a blood culture set?

1 blood culture set consists of 2 bottles, an anaerobic (without oxygen) bottle and an aerobic (with oxygen) bottle